Endoscopic removal of a dental implant through a middle meatal antrostomy

Ear nose and throat surgeons use endoscopic operations on the sinuses not only for chronic paranasal sinusitis but also for other operations. We report the case of a 52-year-old woman in whom we used an endoscopic technique to remove a dental implant that had been displaced into the maxillary sinus. We approached the sinus through the natural ostium, and the foreign body was removed through the widened ostium.     

Cholesterol granuloma of the maxillary sinus

Cholesterol granuloma (CG) is a foreign body reaction to the deposition of cholesterol crystals, usually found in association to chronic middle ear diseases, being highly uncommon in the paranasal sinuses. This article reports a case of CG in the maxillary sinus of a 22-year-old man, manifesting as a swelling on the right maxilla associated with pain and nasal obstruction. Computed tomography (CT) imaging showed complete opacification of the right maxillary sinus with cortical bone expansion and destruction. Incisional biopsy showed a solid mass filling the sinus and histological examination showed foreign body reaction to cholesterol crystals. The microscopic findings associated to tooth vitality, CT images and absence of a cavity during the surgical procedure were compatible with the diagnosis of CG of the maxillary sinus. Complete surgical excision of the mass under general anesthesia was suggested, but the patient did not return to conclude the treatment. CG must be included in differential diagnosis of diseases that cause opacification on the paranasal sinuses, especially sinusitis, and cystic and tumoral lesions.     

Evaluation of maxillary sinus after treatment of midfacial fractures.

PURPOSE: Maxillary sinuses are the most frequently injured anatomic region of the facial skeleton in midfacial fractures. The purpose of this study was to evaluate the patients with maxillary sinus wall fractures using clinical examinations, maxillofacial computed tomography (CT), and cranial bone single-photon emission tomography (SPECT) and to interpret the results of these examinations to evaluate the indications of surgical intervention or drainage for maxillary sinus after maxillary sinus wall fractures. MATERIALS AND METHODS: The results of examinations of 15 patients with maxillary sinus fractures who were treated for midfacial fractures were evaluated. Follow-up examinations were performed in the range of 3 to 47 months after surgery (average, 19.8 months). The patients ranged in age from 10 to 45 years, with an average age of 31.6 years. There were 11 male and 4 female patients. Seven patients had Le Fort II fractures, 6 patients had tripod zygomatic fractures, 1 patient had infraorbital fracture, and 1 patient had zygomatic arch fracture. Operative procedure was performed in all cases. To evaluate maxillary sinus after surgery, maxillofacial computed tomography (CT), cranial bone SPECT, and maxillary sinusitis evaluation form were used in all patients. RESULTS: Maxillofacial CT scans were related to sinusitis in 9 patients who had positive complaints for sinusitis. The cranial bone SPECT showed positive uptake at the fractured sites in 8 patients, minimal uptake in 2 patients, and normal uptake in 5 patients. CONCLUSIONS: Clinical examination, maxillofacial CT, and cranial bone SPECT are the most reliable methods available today for the diagnosis and follow-up of complications of maxillary sinus fractures.     

The management of complications following displacement of oral implants in the paranasal sinuses: a multicenter clinical report and proposed treatment protocols

This study retrospectively analyses paranasal sinus complications following displacement of oral implants in the maxillary sinus treated according to clinical situation by functional endoscopic sinus surgery (FESS), an intraoral approach, or a combination of both procedures. Over 5 years, 27 patients (13 male; 14 female), aged 27–73 years (mean 53.9 years), underwent treatment for postoperative complications involving the paranasal sinuses following displacement of oral implants in the maxillary sinuses. According to the complication (implant displacement, implant displacement with or without reactive sinusitis and/or with or without associated oro-antral communication), patients were treated with FESS, intraoral approach to the sinus, or FESS associated with an intraoral approach. Follow up lasted for at least 1 year with clinical and radiographic controls. 26 patients recovered completely; one patient underwent re-intervention with FESS and an intraoral approach 2 years after implant removal, due to persistent signs and symptoms of maxillary sinusitis and oro-antral communication. Postoperative recovery after the second procedure was followed by complete recovery. The results demonstrate that a rational choice of surgical protocol for the treatment of complications involving the paranasal sinuses following displacement of implants in the maxillary sinuses may lead to reliable results.     

内镜辅助等离子射频消融手术治疗牙源性上颌窦炎近期疗效观察

目的:探讨采用内镜辅助下等离子射频消融手术治疗牙源性上颌窦炎的效果。方法:回顾性分析35例牙源性上颌窦炎患者的资料。其中采用内镜辅助下等离子低温射频治疗患者23例,手术从患侧上颌窦前壁开窗,鼻内镜经中鼻道开口或在开窗处进路,在内镜下探查炎症病灶的具体部位,在去除病灶牙的同时,应用等离子低温射频对上颌窦内病变黏膜部分进行多点消融。其他12例患者采用柯-陆手术治疗,比较2种方法的治疗效果。结果:采用柯-陆手术患者平均住院天数11d,12例患者术后面颊肿胀明显,7例出现面部麻木,6例出现牙疼痛。采用内镜辅助下等离子射频消融手术患者平均住院5d,且未出现上述并发症。内镜辅助射频治疗组术后3个月鼻道窦口完全恢复通畅。35例患者随访3个月时未见复发。结论:与柯-陆手术相比,采用内镜辅助下等离子低温射频消融手术治疗牙源性上颌窦炎在去除病灶的同时,减少了上颌窦黏膜和骨质的损伤,减少患者住院时间,利于术后恢复,临床疗效肯定。     

Treatment of severe sinus infection after sinus lift procedure: a case report

Maxillary sinus floor augmentation may have a variety of postoperative complications including infection, sequestration of bone, and maxillary sinusitis. Complications can also occur due to a preexisting sinus condition called ostium stenosis. This case report presents a complication after sinus lift and grafting procedure due to an unrecognized ostium stenosis. CASE REPORT: A 50-year-old male patient had sinus augmentation on his right side. However, postoperatively, his symptoms were protracted. A CT scan showed thickening of the Schneiderian membrane and scattered graft material. Management included endoscopic nasal examination and ostium enlargement, antibiotic coverage, and full enucleation of the graft and diseased tissue. CONCLUSION: Patency of the sinus ostium should be carefully evaluated before sinus lift/grafting procedure using CT technology. Radiology and otolaryngology consultations may be necessary to rule out ostium stenosis before surgery.     

Frequency of the odontogenic maxillary sinusitis extended to the anterior ethmoid sinus and response to surgical treatment

Objectives: Odontogenic sinusitis usually affects the maxillary sinus but may extend to the anterior ethmoid sinuses. The purpose of this study is to determine the percentage of odontogenic maxillary sinusitis extended to the anterior ethmoid sinuses and determine also the surgical resolution differences between odontogenic maxillary sinusitis and odontogenic maxillary associated to anterior ethmoidal sinusitis. Study Design: This is a retrospective cohort study performed on 55 patients diagnosed of odontogenic sinusitis and treated surgically by functional endoscopic sinus surgery. Results: This study showed that 52.7% of odontogenic maxillary sinusitis spreads to anterior ethmoid, causing added anterior ethmoid sinusitis. We found that 92.3% of the odontogenic maxillary sinusitis (who underwent middle meatal antrostomy) and 96.5% of the odontogenic maxillary sinusitis extended to the anterior ethmoid (treated with middle meatal antrostomy and anterior ethmoidectomy) were cured. Conclusions: Ethmoid involvement is frequent in maxillary odontogenic sinusitis. The ethmoid involvement does not worsen the results of “functional endoscopic sinus surgery” applied to the odontogenic sinusitis. Key words:Odontogenic maxillary sinusitis, ethmoiditis, functional endoscopic sinus surgery.     

Endoscopic surgical treatment of chronic maxillary sinusitis of dental origin.

PURPOSE: Chronic maxillary sinusitis of dental origin (CMSDO) is a common disease that requires treatment of the sinusitis as well as of the odontogenic source. We present our surgical experience performing contemporary treatment of the odontogenic source and endoscopic sinus surgery (ESS) in patients with CMSDO. PATIENTS AND METHODS: Seventeen patients with CMSDO underwent contemporary treatment of the odontogenic source and ESS. Five patients presented chronic oroantral fistula (OAF); 5 patients presented odontogenic cysts occupying the maxillary sinus; 2 patients had inflammatory cysts of the molars; 2 patients had maxillary sinus infection secondary to peri-implantitis; 3 patients had foreign bodies pushed through the root canal into the sinus. The first surgical step was the treatment of the odontogenic source. The second step was ESS with opening and calibration of the maxillary natural ostium. RESULTS: Foreign bodies were extracted from the sinuses through the endonasal approach. No major complications after ESS were observed. The average time for ESS was +/-25 minutes. Good distant results without symptoms and complete closure of the fistula were obtained in all patients. CONCLUSION: When significant sinus disease is found, an endoscopic approach to drainage in all of the involved sinuses can promote predictably successful closure of OAF. The endoscopic approach to chronic maxillary sinusitis of dental origin is a reliable method associated with less morbidity and lower incidence of complications.     

Effects of exposing dental implant to the maxillary sinus cavity

The aim of this study was to evaluate the effects of exposing dental implants to the maxillary sinus cavity. This is a retrospective study. Thirteen patients with 18 implants that had radiographic evidence of implant exposure to the maxillary sinuses participated in this study. We evaluated the patient's radiographs immediately after implant insertion and 12 months after operation with the patient's clinical signs and symptoms due to sinusitis. Thirteen patients with 18 implants in the maxillary sinus had no signs and symptoms of sinusitis. Radiography showed thickening of the sinus membranes in 2 patients. All penetrated implants were successfully integrated, and there were no radiographic signs of bone loss or other complications.The exposure of implants to the maxillary sinuses caused no problems in the maxillary sinuses, and bone formation occurred in THE maxillary floor when penetration of maxillary sinuses occurred without tearing of the membrane.     

上颌窦口扩大手术与蝶腭动脉分支关系的外科解剖研究

目的：了解人体上颌窦口扩大手术与蝶腭动脉分支的解剖关系。方法：30侧动脉灌注乳胶10%福尔马林固定的成人头部标本,不计性别和年龄,在立体放大镜下观察鼻中隔,中鼻道的结构和血管分布。结果：上颌动脉在蝶腭孔处分为蝶腭动脉一终支,经蝶腭孔到鼻腔。其分支供应鼻腔外侧壁,鼻窦及鼻中隔。蝶腭动脉的分支,鼻后外侧动脉的外径为（1.05±0.09）mm,其分支至中鼻甲动脉和下鼻甲动脉,其外径分别为（0.91±0.09）mm和（0.96±0.09）mm。蝶腭动脉的下鼻甲分支在下鼻腔后端前方的距离约为（11±3）mm。在行上颌窦口开放手术时,若距中鼻甲后约1.5cm的距离,不易伤及鼻后外侧动脉。结论：上颌窦口扩大手术中不能单纯以上颌窦开口位置,作为向后上扩大的自然标志,在中鼻甲后端1～1.5mm处,开放上颌窦口较为安全,同时应避免伤及蝶腭动脉的分支及鼻后外侧动脉。     

上颌窦黏膜和窦口在锥体束CT中的解剖学表现

目的:基于锥体束CT( cone beam computed tomography,CBCT)分析上颌窦黏膜和窦口开放性的特点,并分析黏膜和窦口开放性的关系。方法:选取150名患者的CBCT图像资料,共300个上颌窦。使用CBCT测量上颌窦黏膜厚度,记录上颌窦不同的影像特征,并观察窦口的开放性,以开放和阻塞分类。结果:黏膜平均厚度为4.9 mm,大于2 mm者占65.67%,黏膜增厚以2~5 mm最为多见。上颌窦的病变黏膜增厚最为常见,其次为上颌窦囊肿。有10.67%为阻塞窦口。窦口的开放性与黏膜增厚的程度和类型均有显著的相关性。窦口的平均直径为1.76 mm,窦口下界距上颌窦底的平均距离为30.79 mm。结论:术前CBCT扫描时应将窦口包含在内。窦口阻塞和上颌窦存在病变的患者术前应请耳鼻喉专家会诊,特别是病变类型为上颌窦囊肿、部分浑浊液体积累和完全浑浊化者,黏膜增厚大于10 mm者,因为这些患者窦口阻塞的风险增加。     

An interesting reason for chronic sinusitis: firearms injury

Various kinds of etiological factors play a role in chronic sinusitis, and foreign bodies in the sinuses are one of the etiological factors. A 44-year-old man attended our outpatient clinic with complaints of headache, nasal congestion, and postnasal drainage. He had a history of gunshot accident 1 year ago, and his paranasal computed tomography revealed a bullet-shaped, radiopaque foreign body in the right maxillary sinus floor. With the patient under general anesthesia, the foreign body was removed endoscopically. One year after the surgical removal, the patient became free of nasal symptoms.     

CT maxillary sinus evaluation-A retrospective cohort study

Background

Proximity of the dental roots to the sinus floor makes dental disease a probable cause of maxillary sinusitis. The aim of this study was to find out if maxillary sinus pathologic changes were more prevalent in patients with dental disease and to evaluate the performance of computed tomography (CT) in analyzing and detecting apical periodontitis and other odontogenic causes on the maxillary sinusitis etiology in a Portuguese Caucasian population.

Material and Methods

Retrospective cohort study. The total sample of 504 patients and their CT was included in this study. The patients were from a private dental clinic, specializing in oral surgery, where the first complaint was not directly related to sinus disease, but with dental pathology. For each patient, the etiological factors of maxillary sinusitis and the imaging CT findings were analyzed. All the axial, coronal and sagittal CT slices were evaluated and general data were registered. The latter was selected based on the maxillary sinus CT published literature.

Results

32.40% of patients presented normal sinus (without any etiological factor associated), 29.00% showed presence of etiological and imaging findings in the maxillary sinus, 20.60% had only imaging changes in the maxillary sinus and 18.00% of patients presented only etiological factors and no change in the maxillary sinus.

Conclusions

Radiological imaging is an important tool for establishing the diagnosis of maxillary sinus pathology. These results indicate that the CT scan should be an excellent tool for complement the odontogenic sinusitis diagnosis. Key words: Maxillary sinusitis/etiology, odontogenic, computed tomography, maxillary sinus.     

Decreased maxillary sinus volume is a potential predictor of obstructive sleep apnea

ObjectivesTo investigate the associations between nasal airway volume and the presence and severity of obstructive sleep apnea (OSA) in adults.Materials and MethodsThe medical records of adult patients who visited the sleep clinic at University Hospital between June 2013 and April 2017 and underwent overnight polysomnography for the diagnosis of obstructive sleep apnea were reviewed retrospectively. Using computed tomography, the volumes of the nasal airways and maxillary sinuses were measured, and associations with the presence and severity of OSA were analyzed while controlling for the effects of possible confounders such as lateral cephalometric variables, maxillary widths, tongue/hyoid position, and soft palate dimensions.ResultsComparison between normal subjects and patients with OSA revealed that the latter had decreased ratios of maxillary sinus volume to whole nasal airway volume (P = .029) than normal subjects. OSA severity was greater in those with inferior positions of the hyoid (P = .010), in older patients (P = .011), and in those with high body mass index (P = .001). The volume of the total nasal airway or maxillary sinuses were not associated with OSA severity.ConclusionsA decreased ratio of maxillary sinus volume to whole nasal airway volume is associated with adult OSA. However, OSA severity is not associated with either maxillary sinus volume or whole nasal airway volume.     

The value of Waters' projection for assessing maxillary sinus inflammatory disease.

OBJECTIVE: The significance of the Waters' projection for judging maxillary mucosal disease is, at the least, questionable. The aim of this study was to evaluate the diagnostic use of Waters' projection of the maxillary sinus with particular regard to sinus mucosal swelling as a consistent sign of maxillary sinusitis. STUDY DESIGN: Forty consecutive adult patients were referred to an ear, nose, and throat surgeon for pain in the region of the paranasal sinus, recurrent mucopurulent rhinorrhea, and nasal congestion or obstruction for at least 3 months without any response to conservative treatment. Both conventional radiographs (Waters' projection) and coronal and axial computed tomography (CT) scanning of the maxillary sinuses were recorded. The conventional radiographs and CT scans, all made within an hour, were blinded and assessed in random order by 2 independent well-trained observers with standard radiodiagnostic criteria for sinus mucosal swelling. Intraobserver and interobserver agreements were quantified by calculating Cohen's kappa. The diagnostic significance of the Waters' projection was assessed with the CT scan images as criterion standard by calculating sensitivity and specificity, positive predictive value, likelihood ratio, and diagnostic odds ratio. RESULTS: Cohen's kappa for the intraobserver agreement of Waters' examination was 0.96, and the intraobserver agreement for CT scanning was 0.92. The interobserver agreement for Waters' projection and CT scanning was 0.76 and 0.92, respectively. With CT scanning as criterion standard, the sensitivity and specificity of Waters' projections to detect maxillary sinus mucosal swelling were 83.3% and 69.2%, respectively. The positive predictive (diagnostic) value of Waters' projections was 83.3%, the positive likelihood ratio 2.7, and the diagnostic odds ratio 11.25. CONCLUSIONS: From this study it can be concluded that Waters' projections do not necessarily rule out the presence of maxillary sinus mucosal swelling. Additional examinations may be indicated, especially in patients with compromised sinus clearance.     

Malignant tumor involving paranasal sinuses

Carcinoma of the paranasal sinuses is a very serious disease, but its incidence is lower than that of any other oral malignancy. Failure to diagnose it early because of misleading symptoms resembling sinusitis usually leads to its detection at a stage when it has already destroyed the bony walls of the sinus and has spread to surrounding structures (infratemporal fossa, posterior ethmoid cells, orbit, cribriform plate, nasopharynx, sphenoid sinus or base of the skull). It is uncommon for this cancer to spread to the regional lymph nodes as long as it remains confined within the maxillary sinus. CT scanning provides an accurate assessment of the extent of resection required and is usually used as an indicator of operability. A 56-year-old man with a chief complaint of palatal swelling, pain and pus discharge was referred to Seoul National University Dental Hospital. Orthopantomogram and Waters' view revealed an aggressive bone destruction in the right maxillary molar area, ipsilateral sinus opacification and destruction of the lateral wall of the maxillary sinus. The CT fidding showed that the right maxillary sinus was occupied by a soft tissue mass which represented a central low density, with an irregular shape at some levels. The tumor mass also involved the pterygopalatine fossa, right esthmoid sinus, nasal cavity and hard palate. Incisional biopsy was done and the biopsy report was squamous cell carcinoma. He was transferred to Internal Medicine for chemotheraphy because of inoperability.     

Usefulness of combined diagnosis using CT and67Ga scintigraphy in the differentiation of maxillary sinus carcinoma from chronic maxillary sinusitis

Computed tomography (CT) is valuable in differentiating between maxillary sinus carcinoma and chronic maxillary sinusitis because destruction of the maxillary sinus bone wall is the most characteristic finding of maxillary sinus carcinoma. However, some reports have described the existence of chronic maxillary sinusitis with bone destruction of the maxillary sinus walls. Therefore, the CT finding of bone destruction is insufficient to differentiate between maxillary sinus carcinoma and chronic maxillary sinusitis. For this reason, we devised methods of combined diagnosis using CT and⁶⁷Ga scintigraphy to increase the diagnostic accuracy when differentiating between the two conditions. Twenty-four patients with maxillary sinus carcinoma and 13 patients with chronic maxillary sinusitis underwent CT and⁶⁷Ga scintigraphy. The sensitivity, specificity, and accuracy values obtained were 1.00, 0.85, and 0.95, respectively.     

The relationship between patency of the maxillary sinus and craniofacial growth in the rabbit

Numerous researchers report the interaction between deviant respiratory patterns (airway obstruction) and craniofacial growth. Many of these studies consisted of cephalometric evaluations of children with enlarged adenoids, obstruction turbinates, or other nasal obstructions. Other experimental studies of the airway's influence on growth include studies that have induced nasal obstruction in animals by plugging the external nares. No investigations were found that examined the role of the paranasal sinuses in craniofacial growth by filling a sinus in growing animals. Furthermore, nothing appears in the literature that considers the paranasal sinuses in the oronasopharyngeal functional matrix theory. The purpose of this study was twofold: (1) to determine the effect of decreasing the pneumatization of the maxillary sinus on ultimate craniofacial growth and development, and (2) to determine the effect on future morphology by obturating a growing sinus. New Zealand white weaning rabbits were used as the experimental animals. Unilateral maxillary sinuses were injected in 18 animals--nine animals were injected on the right side and nine on the left. Eight rabbits served as controls: five received left-side and three right-side sham injections. Dorsal view cephalometric radiographs were taken at (1) the start, (2) at three progress intervals, and (3) at the end of the experiment. Dried skull direct measurements also were performed at the conclusion of the experiment. No statistical significance was found when comparing right and left sides within groups or when comparing any measurement between groups. This demonstrated that filling the maxillary sinuses had no effect on craniofacial growth; the sinuses grew normally in all animals.     

Respiratory epithelial adenomatoid hamartoma of the maxillary sinus presenting as a periapical radiolucency: a case report and review of the literature

We report a case of respiratory epithelial adenomatoid hamartoma of the left maxillary sinus that initially presented as a periapical radiolucency involving the left maxillary first molar. Respiratory epithelial adenomatoid hamartoma is a rare lesion that occurs in the nasal cavity, paranasal sinuses, and nasopharynx. Most cases are found in the nasal cavity associated with the posterior nasal septum. Involvement of the maxillary sinus is very unusual, and only one other report of a respiratory epithelial adenomatoid hamartoma involving the maxillary antrum was found in a search of the literature. The current case is additionally unique as it was initially detected in the course of a dental examination. Awareness of this lesion is important because inverted schneiderian papilloma and adenocarcinoma may be included in the histopathological differential diagnosis. Conservative surgical removal is curative and recurrence has not been reported.     

Maxillary sinus inflammation after operation of dental implantation and sinus lifting

16 patients with sinusitis were examined after dental implantation and sinus lifting. Possible complication reasons after alveolar process operations were disclosed. For dental implantation efficacy elevation in patients with alveolar process atrophy the consultation of otolaryngologist was necessary in order to disclose hidden pathology on the nasal cavity and sinuses side and also maxillary tomography with inclusion of osteo-meatal complex. Operative treatment of patients with sinusitis after sinus lifting was necessary in case of free lying osteo-plastic material in the sinus, presence of oro-anthral fistula and conservative treatment failure.